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Medical

PPO

HMO

Dental

Life Insurance

   

Standard HMOs

Depending on where you live or work, in many parts of the State, you may also select a Standard HMO.

With a Standard HMO you must use network providers to receive benefits - no benefits are paid when you use out-of-network providers. In addition, set dollar copays keep your costs more predictable.

Plan Highlights

Standard HMOs
Covers care received in network only

No annual deductible

  • Individual
  • Family

 

  • $0
  • $0

What you pay for care received

  • Doctor office visits


  • Hospital stay


  • Prescription drug
    • generic
    • preferred brand
    • non-preferred brand

 

  • $15/visit for PCP; $25/visit for specialists


  • $250


    • $10/retail; $20/mail order
    • $25/retail; $50/mail order
    • $40/retail; $80/mail order

Annual out-of-pocket maximum

  • Individual
  • Family

 

  • $1,500
  • $3,000

Preventive care: routine physical exams, health screenings and immunizations at specified intervals

See the HMO's certificate of coverage for specifics for the HMO you are considering

View a list of the Standard HMOs that will be offered in 2008 and the areas where each is available. The 2008 Benefit Statement you receive in late September 2007 will show the specific HMO options available to you.